Provider Demographics
NPI:1578822870
Name:STODOLKIEWICZ, ANDREW
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:STODOLKIEWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 CHARTRES ST
Mailing Address - Street 2:P.O. BOX 1488
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-1097
Mailing Address - Country:US
Mailing Address - Phone:815-224-1610
Mailing Address - Fax:815-223-1634
Practice Address - Street 1:301 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2312
Practice Address - Country:US
Practice Address - Phone:309-833-2191
Practice Address - Fax:309-836-2118
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor